Provider Demographics
NPI:1073128039
Name:MAHIN N JAHROMI DENTAL GROUP INC
Entity Type:Organization
Organization Name:MAHIN N JAHROMI DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSRATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-827-6407
Mailing Address - Street 1:38985 CHERRY POINT LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8814
Mailing Address - Country:US
Mailing Address - Phone:909-827-6407
Mailing Address - Fax:909-330-2144
Practice Address - Street 1:13677 FOOTHILL BLVD BLDG SUITEM
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0505
Practice Address - Country:US
Practice Address - Phone:909-330-2273
Practice Address - Fax:909-330-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty